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2. Scotland County Planning and Zoning Department
   Fees Are Non-Refundable
4. Application Number
5. Receipt Number
6. Date
   Date
8. Application for
   -- Select One --Appeal per Section 6 of Ordinance 28 N/CConditional Use $300.00Present Zoning DistrictProposed Zoning DistrictRezoning $300.00Subdivision Variance N/CZoning Variance $150.00
12. Applicant
14. Address
16. City
17. State
18. Zip Code
20. Phone Number
24. Owner
26. Address
28. City
29. State
30. Zip Code
32. Phone Number
36. Attach property deed, owner consent form signed and notarized if applicant is not the owner, a copy of the appropriate portion of the Scotland County Tax Map showing location of the subject property and surrounding properties and any pertinent information to support the above request (petitions, supporting letters, etc.)
38. The request is for
40. The property is located at
42. Parcel Identification Number
44. Tax Map Number
45. Block
46. Parcel
48. Parcel Frontage
49. feet and depth of
50. feet and containing
    Square Feet or Acres
52. Indicate any impact(s) on the present area
54. Justification
56. Time schedule for development
    Time schedule for development Start Date

    —

    Time schedule for development End Date
58. I (We) the undersigned, do hereby make application and petition the appropriate Scotland County Board and certify that all statements furnished in this application are true to the best of my (our) knowledge.
60. E-Signature of Applicant *
61. Date
    Date
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64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

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